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Thursday, July 29, 2010

Forget about the law for a moment, and suspend your disbelief: Are patients entitled to reject a particular attending physician because of the doctor's color of her skin, her religious beliefs or for no reason at all? This is the subject of a debate currently ongoing on an international listserv of bioethicists. I must say, I have never given much thought to this issue. I mean, it is straightforward that doctors could not reject to attend to patients for any of those reasons - there are as few conscientious objection rationales for particular procedures, but really even they don't make much sense to my mind and should be rejected. The point is that doctors are professionals and need to act as professionals. Non-professional reasons (aka skin-color, party membership and other such matters) don't count as acceptable rationales for refusing to attend to particular patients.

However, what about patients. There's all sorts of people out there, and some are morons. So, what if a patient doesn't want to be seen by a particular doctor for moronic reasons, say the doctor's membership in a particular church, the doctor's skin color and other non-professional matters. Some of my colleagues, certainly colleagues I hold in high esteem, argue that motives that are unacceptable (eg racist motives) should be ignored and the patient request declined. My gut feeling was initially that that probably is the right approach. Why give in to blatantly racist attitudes for instance. Stuff em I thought.

Well, here's the counter argument: some other bioethicists claim (they did not provide evidence, but let's assume their claim is correct) there is evidence that having to deal with attending doctors that patients can't cope with (for whatever reasons) has a negative impact on health outcomes, and those health outcomes should be our primary concern. That argument persuaded me - that is until I discover that there's no evidence to support the empirical claim I have just outlined.

Tuesday, July 27, 2010

This post doesn't pretend to be deeply insightful... - honestly. I went to a middle-of-the-road fish restaurant in Ottawa the other day. It's called 'The Fish Market'. The food, by the way, in case you do seafood, isn't bad at all. The service is ok for a place that depends probably mostly on tourists visiting Byward Market and that knows that many of its paying customers are once-off events that won't return. I was quite fascinated, when I was about to order a dessert, to discover that they're seriously charging 5C$ (add13% tax, 15% tip and you're closer to 6C$) for - take this - a single shot of espresso. If there ever was a rip-off here it is. You will be hard-pressed to find similar prices even in much more expensive outfits.

The thing with these small details is that their effects accumulate. Bell Canada is charging me for a phone that never worked properly, but, so the company points out to me, in its multi-pages of illegible small-print contract they warned me that they might not offer reception where I actually need it, and also that I have no reason to assume they'd be able to guarantee reception in the GTA, the Greater Toronto Area. Makes sense, doesn't it? Mobile phone reception in Toronto, what a stupid idea! Anyhow, so there I'm paying a monthly fee for a non-functioning phone.

At Queen's, where I work, the outside company that sells food in our cafeterias takes staff and students for a ride in truly breathtaking ways (try York University's cafeterias as a comparison if you don't believe me). Recently they charged for an absolutely mediocre sandwich (white cheapest ever toast bread, tuna) 3,99 C$ + tax. Seriously, producing this sandwich probably cost 40 cents or thereabouts. My complaint remained unanswered, of course. Talking about a captive audience!

And the list goes on and on and on. The big thread is that businesses get away with the proverbial murder in so many different ways. In the restaurant the proprietor knows full-well that many guests like a coffee after their meal, so they'll gulp when they discover the price tag, and cough up the cash. Given that most are tourists anyway, who cares how they feel about having been ripped off. As to Bell, the company knows that it is one of the most widely reviled companies in Canada (right up there with Air Canada and similarly customer hating outfits), so it doesn't care either what people think of it. It's all about milking customers in the short-term, at nearly all cost. Well, and our cafeteria, I'm trying to reduce y exposure to it as good as I can as they don't deserve my business.

I wonder whether this business conduct makes medium- to long-term business sense. I am not even talking business ethics here, just business sense. These organizations surely hurt themselves over time more than their individual disgruntled customers. I have since withdrawn all my business from Air Canada, and come the end of my contract, in my life-time Bell won't get me back as a customer. As to Ottawa's Fish Market. You got to be kidding...

Sunday, July 18, 2010

A fellow Facebook addict from Toronto sent me a message asking me what I thought about the case involving Barbara Seebald and a commentary written by Matthew Weait, a law scholar with particular expertise on HIV/AIDS and human rights issues who is based in London.Weait wrote a monograph arguing that the criminalization of HIV transmission, and indeed the criminalization of infected people who knowingly subject others to the risk of infection, are bad news. He basically thinks that the criminal law ain't a good tool to achieve desirable public health objectives, at least not with regard to HIV/AIDS. This may or may not be true, but - as I have argued in a lengthy review of this book - there can be another good reason for keeping some HIV transmissions a criminal offense, namely the fact that they demonstrably harm other parties. The same case can probably be made for subjecting some third parties to the risk of HIV infection, too. Read my review of his book. I do, in fact, agree with Weait on many HIV policy and legal issues, but I do think there are circumstances were an HIV transmission could constitute reasonably a criminal offense.

Seebald is the second case known to me involving an HIV denialist whose belief that HIV is not the cause of AIDS has translated into serious bodily harm for her offspring. Seebald has chosen not to take antiretrovirals during pregnancy, thereby increasing significantly the risk of her off-spring being HIV positive. One of her children has been hospitalised as a result of HIV-related pneumonia. She breastfed her newborn at the time, thereby further increasing the child's risk of HIV infection. She also misled the midwife assisting in her natural birth to avoid the cesarean section required to reduce the HIV risk. Seebald's children have since been removed from her (yes, they do live with foster parents to protect them against their mother's irresponsible conduct) in order to permit medical doctors to treat them to the best of their professional abilities, an option unavailable to them while the children were with their biological parents. Seebald's - also HIV infected denialist - husband died in May 2010.

As I mentioned, this is the second case that I am aware of that deals with the harmful conduct of HIV denialist parents toward their children. Christine Maggiore, she since died on AIDS, arguably indirectly killed one of her children by ensuring the child did not receive proper medical care.

Matthew Weait, in keeping with what seems his primary legal concern: namely to ensure that the transmission of HIV remains decriminalized (or becomes decriminalized), runs the following line of reasoning to make his case with regard to an Austrian court finding against Barbara Seebald. The court issued a 10-month suspended sentence against Seebald because of her refusal to protect her newborn reasonably against HIV infection. Weait doesn't like the verdict at all. Here are what I take to be the crucial bits from his analysis (please do read his complete analysis here):

He begins by pointing out that for retributive justice to work we need a moral blameworthiness (ie a bad intention - undoubtedly not the case in either Seebald's or Maggiore's case), or the people whose actions we are concerned about need to have been grossly negligent (it's a no-brainer that this applies to both the Seebald as well as the Maggiore cases). I do think Weait's analysis is as seriously flawed as quite some of that presented in his monograph. In this particular instance he rehearses reasons from his monograph that clearly do not apply to these cases. The argument that Seebald and Maggiore were arguably criminally negligent has nothing at all to do with public health concerns (the numbers are too small for this). They have to do with something I elaborated on at great length in my review of his book: gross negligence leading to serious bodily harm to third parties. In this case the third parties were not even volunteering sexual partners, in this case the third parties were these women's own children! As an HIV clinician pointed out in this context: '...infants whose HIV infected mothers listen to AIDS denialists never got the chance to make their own decisions. The Maggiore case received wide publicity. Christine Maggiore is a person who’s proselytized against the use of antiretrovirals to prevent HIV/AIDS. She’s a classic AIDS denialist, and she gave birth to a child who died at age three late last year of an AIDS-related infection. The coroner’s report clearly reports that the child died of AIDS. That was another unnecessary death.'

Weait's analysis, on the other hand is concerned not really about the kids that have been grossly negligently infected by their nuttish mothers, but about the genuinely held dissident views of their parents. How dare we to ignore 'It follows that someone who honestly (even if misguidedly) denies the relationship between HIV and AIDS cannot legitimately be punished for onward transmission of HIV, unless one takes the view that such honest belief is to be ignored' he writes. And further, to drive this important insight home, 'And if we ignore it, then we fail to take seriously the reasons - whatever those might be – for denialism. These might be grounded in a person’s particular life story; or they might result from misinformation or misunderstanding. Whatever its cause, and however difficult it might be to understand that denialism or to sympathise with it, our incomprehension cannot be a sufficient justification for criminalisation and punishment.'

This shows, to my mind, the trap the decriminalization crowd is finding themselves in, with their blanket refusal to acknowledge that there can be circumstances where HIV transmission deserves to be dealt with thru our criminal justice system. Why should it make any difference to our evaluation of the Seebald and Maggiore cases (where idiotic views demonstrably led to serious bodily harm inflicted by these pregnant women on their off-spring), that these people held such idiotic views genuinely, that they ignored overwhelming clinical evidence to the contrary and so on and so forth. Is the argument that their circumstances were such that they were unable to compute the evidence that would have been available to them, had they cared to clear their minds? If this is the argument, perhaps removing their kids from them would have been a sensible choice. It doesn't appear to be the case then that they were strictly speaking competent to bring up these kids to begin with. Surely it is unreasonable to risk one's child's life in order to test the hypothesis of a negligible number of dissident scientists. It's here where Weait moves too quickly to discard the grossly negligible rationale as the basis for a criminal prosecution. This all, of course, is in the service of the blanket decriminalization policy he propagates.

And, just to be on the safe side, Weait quickly throws some mud at those disagreeing with this take, 'doing otherwise effectively makes a failure to accept what most other people believe a sufficient justification for punishment, and that has a frighteningly totalitarian ring to it.' This is bollocks, of course. Failure to believe what other people believe would never lead to punishing anyone, unless that failure leads to the deaths of other parties, or serious bodily harm inflicted upon third parties. Harm to self is fair game, harm to others ain't. That's why even Jehova's Witnesses today in most jurisdictions won't get away with preventing their off-spring from receiving life-preserving blood transfusions when that is clinical indicated. They can harm themselves, but they must not harm others. Nothing totalitarian about this.

Of course, there's never a chance lost to lament 'the effects of HIV-related stigma and prejudice', and so Weait concludes his analysis with general stuff about stigma and prejudice. I pretty much lost it at that point: Here's pregnant women that deliberately decided to disregard mainstream medical advice, and who so chose to risk their children's well-being (with the terrible consequences of death in the Maggiore's child's case, and of life-long serious chronic illness in the Seebald's case). The thing is, virtually all pregnant HIV infected women do NOT act like Seebald and Maggiore, hence Weait's other claim, namely that of 'systemic failures in HIV/AIDS education' is obviously baseless. - None of this has anything at all to do with HIV-related stigma and prejudice.

It goes without saying that these cases are tragic, and thankfully they occur very infrequently. The broader policy point, however, is this: Parents do not own their children. Their kids' lives ain't a free for all. The state has an interest in protecting children against abusive behavior that parents engage in, regardless of whether parents feel strongly that their behavior is not abusive when it actually is. While it might be of interest to Matthew Weait and a lot of sociologists and psychologists to figure out what drives such parents (check out the Darwin Awards in case you've doubts that there's plenty of nutcases out there), at the end of the day society needs to step in and prevent such abuse in its tracks. That's the objective. If currently that can only be achieved thru the criminal justice system, then so be it.

On 24 July 2010 at 2pm join us and make the world stand still in its rage against medievalism and barbarity and in its support of humanity. Sakine, her children and the many others awaiting death by stoning and execution deserve nothing less.

4. To donate to the important work of the International Committee Against Stoning and International Committee Against Executions, please make your cheque payable to ‘Count Me In – Iran’ and send to BM Box 6754, London WC1N 3XX, UK. You can also pay via Paypal (http://countmein-iran.com/donate.html). Please earmark your donation.

Tuesday, July 13, 2010

Here's a tricky case involving academic freedom at the University of Illinois at Urbana Champaign. The University fired a Catholic instructor because he wrote this letter to students in a class he taught on (get this) 'Utilitarianism and Sexuality'.

The academic in question didn't actually have tenure, he was an adjunct instructor. In his letter he states - among other things - the following:

'To the best of my knowledge, in a sexual relationship between two men, one of them tends to act as the "woman" while the other acts as the "man." In this scenario, homosexual men have been known to engage in certain types of actions for which their bodies are not fitted. I don't want to be too graphic so I won't go into details but a physician has told me that these acts are deleterious to the health of one or possibly both of the men. Yet, if the morality of the act is judged only by mutual consent, then there are clearly homosexual acts which are injurious to their health but which are consented to. Why are they injurious? Because they violate the meaning, structure, and (sometimes) health of the human body.'

What wrong about this statement?1) It is not the case that in same sex relationships one of the partners necessarily acts as the 'woman' and the other one acts as the 'man'. Even if this was the case, nothing at all followed normatively.2) Empirically it makes no sense at all to speak of people engaging in sexual acts that their bodies are not fitted (by whom?) to undertake. Everything that we are physically able to undertake with our bodies are able ('fitted'?) to do.3) It is question begging to claim that a sex act violates the meaning of our bodies? As in 'how', 'why', 'by means of what'? Are we violating our bodies each time we engage in sexual acts for the fun of it as opposed to in order to breed? What's he on about here?4) What is meant by the 'structure of the human body' being violated by a same sex act?

And so he concludes,

'Catholics don't arrive at their moral conclusions based on their religion. They do so based on a thorough understanding of natural reality.'

This, of course, is patently untrue and unprofessional a statement. By necessity Catholics (qua Catholics) arrive at their moral conclusion about sexuality (amongst others) by means of a normative understanding of natural reality (ie their interpretation of what nature, especially human nature ought to be like, as opposed to what it really is like). For that reason the preacher (aka teacher) sneaks in Natural Moral Law and Reality. Really he's saying that natural law theory thinks that human reality ought to be such and such, when quite obviously it is different. The problem then ain't with the theory but with our behavior. All quite silly stuff to be honest.

Was it sensible to fire him? Well, given that the topic of the class was 'Utilitarianism and sexuality' (I can't see how anyone could teach that topic for a whole term, but hey), he clearly went on an agitprop exercise, even trying to hide is real reasons (Catholic doctrine) by claiming that his views have nothing to do with religion. He said, for instance, 'As a final note, a perceptive reader will have noticed that none of what I have said here or in class depends upon religion.' That's a plain lie. No wonder his University chose to take him down.

A nice analysis of some other nonsense in the good preacher's email to his students can be found at the - as ever - dependable Pharyngula.

Wednesday, July 07, 2010

The UK Supreme Court issued a finding today that gay refugees from countries that discriminate against homosexuality may not be send back to their home countries if there is a risk that they might be persecuted at home. The new conservative-liberal government promised to implement the ruling immediately, adding that they already have stopped sending such refugees back to their home countries. Initially, UK Home Office officials came up with the ingenious idea that gay people, after their deportation, should simply hide their sexual orientation at home, and so they would be fine. Lower courts agreed with the Home Office proposition, but the justices of the Supreme Court decided that that would constitute a violation of these gay people's human rights.

Deputy court president Lord Hope said in his ruling: "The ultra-conservative interpretation of Islamic law that prevails in Iran is one example. The rampant homophobic teaching that rightwing evangelical Christian churches indulge in throughout much of sub-Saharan Africa is another."

A "huge gulf" had opened up in attitudes towards gay people, he said. "It is one of the most demanding social issues of our time. Our own government has pledged to do what it can to resolve the problem, but it seems likely to grow and to remain with us for many years." More gay and lesbian people were likely to have to seek protection in this country if it was denied in their home countries, he said.

Another member of the court, Lord Rodger, said normal behaviour of gay people must be protected just as it was for heterosexual people. "What is protected is the applicant's right to live freely and openly as a gay man. To illustrate the point with trivial stereotypical examples from British society: just as male heterosexuals are free to enjoy themselves playing rugby, drinking beer and talking about girls with their mates, so male homosexuals are to be free to enjoy themselves going to Kylie concerts, drinking exotically coloured cocktails and talking about boys with their straight female mates."

Leaving aside for a moment the characterization of gay men as being typically this or being typically that, the point is well taken that if this is how you express your identity you have every right in the universe to do so without risking your life. You can see how important this judgment is when you look at how bad the situation for gay people in many countries is.

Tuesday, July 06, 2010

Imagine my surprise when I read in today's paper about a judgment from Germany's Federal Court in a case determining the legality or otherwise of pre-implantation diagnosis. Just so you get the significance of this, here's a blurb from Wikipedia about the relevance of the Federal Court in Germany's legal pecking order: 'The Federal Court of Justice of Germany (German: Bundesgerichtshof, BGH) is the highestcourt in the system of ordinary jurisdiction (ordentliche Gerichtsbarkeit) in Germany. It is the supreme court (court of last resort) in all matters of criminal and private law. A decision handed down by the BGH can only be reversed by the Federal Constitutional Court of Germany in rare cases when the Constitutional Court rules on constitutionality (compatibility with the Basic Law for the Federal Republic of Germany).'

The Court determined that it is OK to check for serious genetic defects of embryos prior to implantation in couple with known serious genetic illnesses. In one of the cases the woman considering conceiving another child had already given birth to a disabled daughter, another woman went thru three failed pregnancies. It goes without saying that embryos that are non implanted after PID took place (ie after serious genetic defects have been diagnosed) will be destroyed.

Critics have trotted out the usual stuff like that this discriminates against the disabled, and that this takes us on a slippery slope to designer babies (ie selection in favor of blue eyed kids was mentioned). It is true that the court judgment takes a clear stance on the former issue. If at the embryonic stage it is possible to make a choice between a future seriously disabled child and a healthy (healthier) child, the latter is preferable and it is up to pregnant women to decline the implantation of the embryo known to be defective. On the latter issue, currently such choices would not be covered by the judgment, but frankly, what if someone chose blue eyes over brown eyes, or brown eyes over blue eyes, what danger would this really entail? If someone - like me - subscribes to the ethical stance (as I do) that women are very much entitled to make reproductive choices entailing abortions, for any reason or none, why should it matter that they decline the implantation of an embryo with the wrong eye color?

I do think my progressive friends need to think carefully about whether or not they support unconditionally a woman's right to make reproductive choices. If they do, the above mentioned slippery slope arguments must not faze them.

Monday, July 05, 2010

Having just redeemed themselves in the eyes of regular readers with pretty sharp reporting about the Dudus' affair, Jamaica's journalism is back to its usual quality-wise lows.

Two of Jamaica's papers, the Observer and the Gleaner have a long and distinguished history of anti-gay agitprop. The Gleaner frequently does it under the guise of pseudo-openness perpetuated by one of its columnists. He's a quite eloquent chap who likes to gives his musings an air of scientific soundness when really he picks and chooses biased academic content usually from low-ranking academic journals likely gleaned from the Family Research Council's (or some other Christian fundamentalist organisation like it) treasure chest of anti-gay 'research'. You know, the kind of research 'demonstrating' that gays are more likely to rape little kids, murder your grannie and have a hotline to the devil. A long running Jamaican agitprop feature on that front has been this: Antigay violence in Jamaica ain't the real problem (empirical research undertaken by international human rights organisations be damned) but violent gay men beating each other up are the real problem.

Here's an example taken from the Observer. In last Sunday's edition, under the byline of 'DONNA HUSSEY-WHYTE Sunday Observer staff reporter', the campaign continues. Hussey-Whyte notes in her introductory line that 'Many may argue that the gay community is falsely accused of excessive violence against its own members, but the horrible wounds on Keron Brown's body tell a different story.” Her story is about a gay man who she reports has been abused pretty badly by his partner and that partner's mates. Assuming that the case is true – I have no way to verify it, but it's perfectly possible, of course, that a gay man was abused by his partner – nothing follows with regard to how the average gay person treats his or her partner(s).

No doubt Donna Hussey-Whyte doesn't know what inductive reasoning is, and even less why we know that such modes of analysis don't work as a scientific method. So, to her benefit: You can't really use anecdotal cases to make a general point. Say, assume I see someone jumping out of a 10th floor window and ending up on the ground floor without injury. I shouldn't make that the story line of an article suggesting that generally speaking it's sensible to assume that jumping out of 10th floor windows isn't a risky activity. I'm sure you get the drift. So, before Donna Hussey-Whyte's agitprop piece even goes into full swing, anyone who took Scientific Method 101 knows already that not only is her first sentence wrong, but more importantly, that anyone can know with certainty that her story can't prove her point about the gay community being pretty violent against its own members. It's not even clear what she means with gay community to be honest. Is her proposition that the average gay person is more likely, or a membership club called 'gay community' or is something else tickling her incisive reporting mind?

Anyhow, back to Donna Hussey-Whyte's agitprop piece: Just think of a counter example of similar disingenuity, think of the number of crimes committed by heterosexual people in Jamaica. Most of those crimes are committed against other heterosexual people. Would this tell us anything at all about a purported link between heterosexuality and violent behaviour? Not at all – that is unless you're Donna Hussey-Whyte. Oddly, she never filed this particular investigative report. Makes you wonder why...

Having said that, from societies more peaceful than the Jamaican we do know that gay people are – if anything – less prone to be violent than their straight counter parts. Is it possible that anti-gay violence and general societal homophobia cause possibly surplus violence among gay people that otherwise would not exist? This truly is an interesting question, if we accept the local media's as yet unsubstantiated premise that gay people in Jamaica are really more prone to abuse each other than they are in other countries. Do we know whether they are more prone to this sorts of behaviour than they are in other countries, or do we know whether they're more prone to violence than are heterosexual people in Jamaica? We know none of this, unless we believe that Donna's inductive 'reasoning' is a good substitute for actual evidence.

As ever, beware of Jamaica's newsmedia when it comes to the issue of homosexuality. Their reporting is by and large in the service of anti-gay prejudice. It's mostly propaganda, no more, no less.

Friday, July 02, 2010

The time honored barbarism of killing young (South) African men in that traditional practice of circumcision has again yielded a decent crop of dead men in South Africa. Reportedly about 150 young men died in circumcision ceremonies (or as a result of their participation) between the beginning of 2008 and the end of 2009. So-called traditional healers (elevated to a profession under the able guidance of the late Dr Beetroot, the former South African health minister and arch AIDS denialist Manto Tshabalala-Msimang) are frequently involved in botched circumcisions, causing so substantial numbers of avoidable deaths. The opposition DA party suggests that the actual circumcision should take place in a hospital. Now that's a thought.

Of course, there will be those who say that circumcision is always wrong, and - my own preferences to the contrary notwithstanding - there's some truth in that. The thing is though, since we have fairly strong evidence that circumcision dramatically reduces the risk of catching HIV there's probably a public health argument to be had - in Southern Africa - for undertaking circumcisions. Wouldn't it be nice though, if authorities in that country managed to have them conducted in such a way that not so many young men needlessly lose their lives over them?